Healthiest Wisconsin 2020 Baseline and Health Disparities Report Environmental and Occupational...

Wisconsin Department of Health Services

January 2014 P-00522G

Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Environmental and Occupational Health

ENVIRONMENTAL AND OCCUPATIONAL HEALTH

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Healthiest Wisconsin 2020 objectives and indicators• Rationale• Key points

Data• Youth asthma• Adult asthma• Asthma hospitalizations• Occupational injury• Lead poisoning

ReferencesLinks to additional reports and resourcesContacts

Chapter Outline

Chapter outline

2


Report Overview

• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.

• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.

• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

3

http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf



Report Format

Full Report• Format: PDF • Intended use: reference document

Chapters• Format: Annotated PowerPoint slide

set• Intended uses: presentations to

– Decision-makers– Service providers– Community leaders– The public

Sample annotated slide

Report overview

4


Report Outline

Executive Summary

Section 1: Introduction

Section 2: Demographic overview

Section 3: Health focus areas

Section 4: Infrastructure focus areas

Section 5: Data summaries by population

Section 6: Technical notes

Report overview

5


Report Outline: Detail

Section 3: Health focus areas

• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure

Section 4: Infrastructure focus areas• Access to health care

Report overview

6


Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography

Report overview

7


Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.

• Population estimates that are considered unreliable are excluded.

• Misclassification of racial/ethnic groups may affect the accuracy of rates.

• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

Report overview

8



Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

9


Healthiest Wisconsin 2020 objectives and indicators

Objective 1

By 2020, improve the overall quality and safety of the food supply and the natural, built and work environments.

Objective 1 Indicator

• Proportion of local and tribal jurisdictions that have assessed, prioritized and improved performance on an environmental and occupational health index.

Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Environmental and Occupational Health Focus Area Profile.

HW2020 objectives

10


Healthiest Wisconsin 2020 objectives and indicators

Objective 2

By 2020, increase the percentage of homes with healthy, safe environments in all communities.

Objective 2 Indicator

• Proportion of local and tribal jurisdictions that have assessed, prioritized and improved performance on a home health and safety index.


HW2020 objectives

11


Rationale

• Environmental and occupational health includes the prevention of illnesses and injuries resulting from hazards in the natural and built environments where people live, work and play.

• The air we breathe, water we drink, communities we live in, and food we eat are recognized as underlying determinants of health.

• Disparities in the quality of living spaces are often related to socioeconomic, racial/ethnic, and income- and education-level factors. These factors can affect whether or not environmental contaminants are detected and removed.


Rationale

12


Key points

• Black adults had significantly higher percentages of lifetime and current asthma compared to other racial/ethnic groups.

• Lifetime and current asthma rates are significantly higher among people with lower incomes and those with lower educational attainment.

• While the statewide rate of asthma hospitalization has declined slightly over the past 10 years, notable disparities exist by race. The hospitalization rate was five times greater for the Black population and two times greater for American Indians than for the White population.

• Milwaukee and Menominee counties had asthma hospitalization and emergency department visit rates that were roughly twice the statewide rates.

• The estimated rate of work-related injury and illness has declined over the past decade.

• Lead poisoning has steadily decreased among children under age six since 2001; however, racial and ethnic disparities remain. In 2010, Black children were six times as likely as White children to have experienced lead poisoning.

Key points

13


Youth asthma

14


Rates of lifetime and current asthma among Wisconsin children, by sex, 2011-2012

Youth asthma

Have ever been told you have asthma

Currently have asthma0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

11% 8%13% 9%9% 6%

TotalMaleFemale

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2011-2012 landline-cellphone combined dataset.

15


Rates of lifetime asthma among public middle and high school students, by race/ethnicity, Wisconsin, 2008 and 2010

Source: Wisconsin Department of Health Services, Youth Tobacco Survey, 2008 and 2010.Note: “Other” includes Hispanic, American Indian/Alaskan Native, Asian, Native Hawaiian or other Pacific Islander.

White, non-Hispanic Black, non-Hispanic Other0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

12% 16% 12%12% 26% 11%

20082010

Youth asthma

16


Adult asthma

17


Rates of lifetime and current asthma among Wisconsin adults, by sex, 2009-2011

Adult asthma


Have ever been told you have asthma Currently have asthma0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

13% 9%11% 7%15% 11%

Total Male

Female

18


Rates of lifetime and current asthma among Wisconsin adults, by age, 2009-2011



5%

10%

15%

20%

25%

30%

18% 10%14% 9%11% 9%11% 9%

18 - 2425 - 4445 - 6465+

Adult asthma

19


Age-adjusted rates of asthma among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.


5%

10%

15%

20%

25%

30%

13% 9%23% 16%13% 9%10%

WhiteBlackHispanicAmerican Indian

Adult asthma

20


Age-adjusted rates of asthma among Wisconsin adults, by income level, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.


5%

10%

15%

20%

25%

30%

22% 18%13% 9%10% 7%

Low income (<$20,000)

Middle income ($20,000-$74,999)

High income ($75,000+)

Adult asthma

21


Age-adjusted rates of asthma among Wisconsin adults, by level of urbanization, 2008-2011



5%

10%

15%

20%

25%

30%

14% 11%15% 10%11% 8%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

Adult asthma

22


Rates of lifetime and current asthma among Wisconsin adults, by sexual orientation, 2008-2011


Adult asthma


5%

10%

15%

20%

25%

30%

13% 9%16% 10%

Sexual majoritySexual minority

23


Asthma hospitalizations

24


Asthma hospitalizations, age-adjusted rate per 10,000, Wisconsin, 2001-2010

Source: 2001-2010 hospital inpatient discharge file.


2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

2

4

6

8

10

12

Year

Age-

adju

sted

rate

per

10,

000

popu

-la

tion

25


Asthma hospitalizations by race/ethnicity, age-adjusted rate per 10,000, Wisconsin, 2010

Source: Wisconsin Inpatient Hospitalization Discharge file, 2010.


White Black Hispanic Asian American Indian

0.0

2.0

4.0

6.0

8.0

10.0

12.0

26


Asthma hospitalizations by age and sex, rate per 10,000, Wisconsin, 2010

Source: 2010 Wisconsin inpatient hospitalization discharge file.


0-4 5-14 15-34 35-64 65+ All ages0

5

10

15

20

25

30

35

30 10 2 5 10 716 7 4 12 17 10

MaleFemale

Age Group (years)

Age-

adju

sted

rate

per

10,

000

popu

-la

tion

27

ENVIRONMENTAL AND OCCUPATIONAL HEALTHCounties exceeding the statewide age-adjusted rates per 10,000 of asthma hospitalizations and emergency department visits, Wisconsin, 2008-2010

Source: 2008-2010 Wisconsin hospital inpatient discharge file; 2008-2010 Wisconsin emergency department visit file.


Asthma health care utilization

Both hospitalization and emergencydepartment rates exceed state rate

Neither hospitalization or emergency department rate exceeds state rate

Hospitalization rate exceeds staterate (9 per 10,000)

Emergency department rate exceeds state rate (38 per 10,000)

28


Distribution of asthma hospitalizations by primary payer, Wisconsin, 2010

Commercial, 27%

Self pay, 6%

Medicare, 33%

Medicaid, 33%

Other government programs, 1%

Source: 2010 Wisconsin hospital inpatient discharge file.


Asthma hospitalizations in 2010:Number: 4,949Average hospitalization charge: $12,420

Governmental payers

Non-governmental payers

29


Asthma hospitalizations among Medicaid recipients by race/ethnicity, rate per 10,000, Wisconsin, 2007-2009

Source: Wisconsin Division of Health Care Access and Accountability, 2007-2009 Medicaid Data.Note: White, Black, and American Indian are non-Hispanic; Hispanic may include people of any race.

White Black Hispanic Asian American Indian0

10

20

30

40

50

60

70

30 50 30 10 3020 50 30 10 3020 60 30 20 40

200720082009

Rat

e pe

r 10,

000

enro

llees


30


Occupational injury

31

ENVIRONMENTAL AND OCCUPATIONAL HEALTHEstimated work-related nonfatal injury/illness incidence rate and crude fatality rate per 100,000 full-time-equivalent workers (FTEs) age 16 years or older, Wisconsin, 2001-2010

Source: U.S. Bureau of Labor Statistics Survey of Occupational Illnesses and Injuries and U.S. Bureau of Labor Statistics Census of Fatal Occupational Injuries.

Occupational injury

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0Nonfatal injury/illness rate Fatality rate

Estim

ated

inju

ry a

nd il

lnes

s ra

te p

er

100,

000

FTEs

Ann

ual c

rude

fata

lity

rate

per

100

,000

FT

Es

32


Lead poisoning

33


Percent of children under age six who were lead tested and had a confirmed elevated blood lead level, by state, 2010

Source: Centers for Disease Control and Prevention (CDC) Lead Program, National Surveillance data. Data exclude children who have been previously tested and found to have elevated blood lead levels.

Lead poisoning

Series1

-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

United States = 0.61%

34


Number of Wisconsin children under age six who were lead tested and lead poisoned (10 mcg/dL or higher), Wisconsin, 2001-2010

Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).

Lead poisoning

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

1,000

2,000

3,000

4,000

5,000

6,000

0

20,000

40,000

60,000

80,000

100,000

120,000Tested Poisoned

Num

ber o

f chi

ldre

n un

der a

ge s

ix

lead

-poi

sone

d

Num

ber o

f chi

ldre

n un

der a

ge s

ix t

este

d fo

r blo

od le

ad

35


Annual prevalence of lead poisoning (10 mcg/dL or higher) among tested children under age six, by race/ethnicity, Wisconsin, 2000-2010


2001 2002 2003 2004 2005 2006 2007 2008 2009 20100%

5%

10%

15%

20%

25% BlackHispanicAsianWhite

Year

Lead poisoning

36


Annual mean blood lead level (mcg/dL) for tested children under age six, by race/ethnicity, Wisconsin, 2010

Source: Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).Note: Racial groups are non-Hispanic; Hispanics may include any race.

White Black Hispanic Asian American Indian0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

2.7 4.1 3.2 2.9 2.3

Mea

n bl

ood

lead

leve

l (m

cg/d

L)Lead poisoning

37


Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by Medicaid enrollment, Wisconsin, 2010


Percent with lead poisoning (≥10 µg/dL)

-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

0.7% 1.6%

Non-Medicaid enrolleesMedicaid enrollees

Lead poisoning

38


Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by county, Wisconsin, 2010


Lead poisoning

Elevated blood lead level

0% - 0.3%

0.4% - 0.7%

0.8% - 1.3%

1.4% - 2.4%

Statewide = 1.3%

39


References

1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach

2. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

6. Centers for Disease Control and Prevention (CDC). Asthma. http://www.cdc.gov/asthma/faqs.htm

7. CDC. Adolescent and School Health: Asthma and Schools. http://www.cdc.gov/healthyyouth/asthma/index.htm

8. American Lung Association. Asthma and Children. http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html

References

40

http://www.countyhealthrankings.org/our-approach

http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

http://www.cdc.gov/asthma/faqs.htm

http://www.cdc.gov/asthma/faqs.htm

http://www.cdc.gov/healthyyouth/asthma/index.htm

http://www.cdc.gov/healthyyouth/asthma/index.htm

http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html




9. Wisconsin Department of Health Services (DHS). Burden of Asthma in Wisconsin 2010: http://www.dhs.wisconsin.gov/eh/asthma/pdf/BurdenofAsthma2010Web.pdf

10. U.S. Department of Health and Human Services, Office of Minority Health. Asthma and African Americans. http://minorityhealth.hhs.gov/templates/content.aspx?ID=6170

11. Leigh, JP. Individual and job characteristics as predictors of industrial accidents. Accident Analysis and Prevention, 1986; 18(3).

12. National Institute for Occupational Safety and Health. Occupational Health Disparities. http://www.cdc.gov/niosh/programs/ohd/

13. DHS. The Legacy of Lead: Report on Childhood Lead Poisoning in Wisconsin 2008: http://www.dhs.wisconsin.gov/lead/doc/LegacyofLead2008webpage.pdf

14. DHS. Lead-Safe Wisconsin: Action level changed from blood lead level of 10 to 5. http://www.dhs.wisconsin.gov/lead/

References

41

http://www.dhs.wisconsin.gov/eh/asthma/pdf/BurdenofAsthma2010Web.pdf


http://minorityhealth.hhs.gov/templates/content.aspx?ID=6170

http://minorityhealth.hhs.gov/templates/content.aspx?ID=6170

http://www.cdc.gov/niosh/programs/ohd/

http://www.cdc.gov/niosh/programs/ohd/

http://www.dhs.wisconsin.gov/lead/doc/LegacyofLead2008webpage.pdf


http://www.dhs.wisconsin.gov/lead/


Links to additional reports and resources

• Burden of Asthma in Wisconsin 2010: http://www.dhs.wisconsin.gov/eh/asthma/pdf/BurdenofAsthma2010Web.pdf

• Wisconsin Asthma Plan 2009-2014: http://www.dhs.wisconsin.gov/eh/Asthma/pdf/WACPlan20092014.pdf

• Wisconsin Occupational Health Program Website: http://www.dhs.wisconsin.gov/dph_boh/occ/pages/index.htm

• The Legacy of Lead: Report on Childhood Lead Poisoning in Wisconsin 2008: http://www.dhs.wisconsin.gov/lead/doc/LegacyofLead2008webpage.pdf

• Centers for Disease Control and Prevention (CDC). Environmental Health: http://www.cdc.gov/Environmental/

• CDC. Environmental Health: Workplace Health and Safety: http://www.cdc.gov/Workplace/

Links

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http://www.dhs.wisconsin.gov/eh/Asthma/pdf/WACPlan20092014.pdf

http://www.dhs.wisconsin.gov/dph_boh/occ/pages/index.htm



http://www.cdc.gov/Environmental/



http://www.cdc.gov/Workplace/




Contacts

Carrie Tomasallo, PhD, MPHSenior EpidemiologistBureau of Environmental and Occupational HealthDivision of Public HealthWisconsin Department of Health ServicesEmail: [email protected]

Marjorie Coons, MSProgram ManagerWisconsin Healthy Homes and Childhood Lead Poisoning Prevention ProgramBureau of Environmental and Occupational HealthDivision of Public HealthWisconsin Department of Health ServicesEmail: [email protected]

Contacts

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mailto:[email protected]

mailto:[email protected]

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